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Why We Should Prioritize Preventive Approaches to Mental Health

Contributors to mental illness like poverty and inequality need to be addressed.

Key points

  • If psychosurgery and lobotomy was psychiatry's "last resort" 75 years ago, social psychiatry and prevention should be the first resort.
  • Social psychiatrists showed that poverty, inequality, and community disintegration were linked to mental illness.
  • Universal Basic Income could be a key strategy in a new preventive mental health policy for the 21st century.

About 20 years ago, I was introduced to the history of psychiatry. This introduction came in the form of a book, The Last Resort: Psychosurgery and the Limits of Psychosurgery (1998) by the late Jack D. Pressman. Pressman's topic was lobotomy, which had emerged in the 1930s and became a popular treatment for a variety of mental disorders during the 1940s and 1950s, especially in North America and Scandinavia. The book addressed a question that many have asked: Why did this apparently barbaric procedure become so prevalent?

The title of Pressman's book provides a hint. He argued that psychiatrists (and to a lesser extent, patients and their families) turned to lobotomy out of desperation. Lacking the psychotropic drugs that would emerge during the 1950s and amidst the contemporary emergence of other somatic treatments, such as electroconvulsive therapy (ECT) and insulin shock therapy, psychotherapy seemed acceptable as a last resort.

Nearly 20 years later, I had my own book on the history of social psychiatry to publish. But I didn't have a title. The working title had always been "An Ounce of Prevention" because social psychiatry was a preventive approach to mental health. My publisher, however, had other plans. Apparently, there were way too many books (including many self-help books) that had "Ounce of Prevention" in the title. Stumped, I started to look at the titles of other books on the history of psychiatry and, before too long, I was looking at the cover of Pressman's seminal monograph. My book, The First Resort: The History of Social Psychiatry in the United States, now had a title.

My rationale for the title was pretty obvious: If psychosurgery was considered the last resort psychiatry should turn to, then social psychiatry and its preventive approach should be the first resort. Indeed, prevention dominated thinking about mental illness during the years after the Second World War, the years when the National Institute for Mental Health was founded and social psychiatry was all the rage. But by the 1970s, such approaches were starting to fade. Psychiatrists were increasingly turning to drug therapies and the political heft behind preventive psychiatry was ebbing. Whenever I mention social psychiatry to audiences of mental health professionals, very few people are unfamiliar with the term, let alone what it means. I hope my book changes that.

Poverty, inequality, and mental illness

We need to prioritize prevention if we are to have any hope of stemming the rising tide of mental illness. Prevention needs to be at the top of our mental health to-do list, not lingering near the bottom. Sixty years ago, social psychiatrists were very good at demonstrating that poverty, inequality, and community disintegration contributed to mental illness. They weren't very good (or perhaps willing) at articulating what to do about this association.

Universal Basic Income as a preventive strategy

As I have argued in my posts, one thing we could do today is to consider Universal Basic Income as a foundation for a more preventive mental health strategy. UBI would help to alleviate many of the factors that social psychiatrists identified as bad for mental health. It could also provide the platform for other preventive mental health policies. There are many other things we could do, too, if the energies and insights of mental health researchers and workers could shift from focusing on how to treat mental illness to how to prevent it better. Prevention should be our first resort.


Smith, M (2023). The First Resort: The History of Social Psychiatry in the United States. New York: Columbia University Press.

Pressman, J.D. (1998) Last Resort: Psychosurgery and the Limits of Medicine. Cambridge: Cambridge University Press.

The First Resort: The History of Social Psychiatry in the United States Source: MilendaNan Ok Lee, used with permission.
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